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Sink drainage systems are not amenable to standard methods of cleaning and disinfection. Disinfectants applied as a foam might enhance efficacy of drain decontamination due to greater persistence and increased penetration into sites harboring microorganisms.
To examine the efficacy and persistence of foam-based products in reducing sink drain colonization with gram-negative bacilli.
During a 5-month period, different methods for sink drain disinfection in patient rooms were evaluated in a hospital and its affiliated long-term care facility. We compared the efficacy of a single treatment with 4 different foam products in reducing the burden of gram-negative bacilli in the sink drain to a depth of 2.4 cm (1 inch) below the strainer. For the most effective product, the effectiveness of foam versus liquid-pouring applications, and the effectiveness of repeated foam treatments were evaluated.
A foam product containing 3.13% hydrogen peroxide and 0.05% peracetic acid was significantly more effective than the other 3 foam products. In comparison to pouring the hydrogen peroxide and peracetic acid disinfectant, the foam application resulted in significantly reduced recovery of gram-negative bacilli on days 1, 2, and 3 after treatment with a return to baseline by day 7. With repeated treatments every 3 days, a progressive decrease in the bacterial load recovered from sink drains was achieved.
An easy-to-use foaming application of a hydrogen peroxide- and peracetic acid-based disinfectant suppressed sink-drain colonization for at least 3 days. Intermittent application of the foaming disinfectant could potentially reduce the risk for dissemination of pathogens from sink drains.
The National Institute of Health has mandated good clinical practice (GCP) training for all clinical research investigators and professionals. We developed a GCP game using the Kaizen-Education platform. The GCP Kaizen game was designed to help clinical research professionals immerse themselves into applying International Conference on Harmonization GCP (R2) guidelines in the clinical research setting through case-based questions.
Students were invited to participate in the GCP Kaizen game as part of their 100% online academic Masters during the Spring 2019 semester. The structure of the game consisted of 75 original multiple choice and 25 repeated questions stemming from fictitious vignettes that were distributed across 10 weeks. Each question presented a teachable rationale after the answers were submitted. At the end of the game, a satisfaction survey was issued to collect player satisfaction data on the game platform, content, experience as well as perceptions of GCP learning and future GCP concept application.
There were 71 total players who participated and answered at least one question. Of those, 53 (75%) answered all 100 questions. The game had a high Cronbach’s alpha, and item analyses provided information on question quality, thus assisting us in future quality edits before re-testing and wider dissemination.
The GCP Kaizen game provides an alternative method for mandated GCP training using principles of gamification. It proved to be a reliable and an effective educational method with high player satisfaction.
Decision-makers need readily accessible tools to understand the potential impacts of alternative policies on forest cover and greenhouse gas (GHG) emissions and to develop effective policies to meet national and international targets for biodiversity conservation, sustainable development and climate change mitigation. Land change modelling can support policy decisions by demonstrating potential impacts of policies on future deforestation and GHG emissions. We modelled land change to explore the potential impacts of expert-informed scenarios on deforestation and GHG emissions, specifically CO2 emissions, in the Ankeniheny–Zahamena Corridor in eastern Madagascar. We considered four scenarios: business as usual; effective conservation of protected areas; investment in infrastructure; and agricultural intensification. Our results highlight that effective forest conservation could deliver substantial emissions reductions, while infrastructure development will likely cause forest loss in new areas. Agricultural intensification could prevent additional forest loss if it reduced the need to clear more land while improving food security. Our study demonstrates how available land change modelling tools and scenario analyses can inform land-use policies, helping countries reconcile economic development with forest conservation and climate change mitigation commitments.
Important Bird and Biodiversity Areas (IBAs) are sites identified as being globally important for the conservation of bird populations on the basis of an internationally agreed set of criteria. We present the first review of the development and spread of the IBA concept since it was launched by BirdLife International (then ICBP) in 1979 and examine some of the characteristics of the resulting inventory. Over 13,000 global and regional IBAs have so far been identified and documented in terrestrial, freshwater and marine ecosystems in almost all of the world’s countries and territories, making this the largest global network of sites of significance for biodiversity. IBAs have been identified using standardised, data-driven criteria that have been developed and applied at global and regional levels. These criteria capture multiple dimensions of a site’s significance for avian biodiversity and relate to populations of globally threatened species (68.6% of the 10,746 IBAs that meet global criteria), restricted-range species (25.4%), biome-restricted species (27.5%) and congregatory species (50.3%); many global IBAs (52.7%) trigger two or more of these criteria. IBAs range in size from < 1 km2 to over 300,000 km2 and have an approximately log-normal size distribution (median = 125.0 km2, mean = 1,202.6 km2). They cover approximately 6.7% of the terrestrial, 1.6% of the marine and 3.1% of the total surface area of the Earth. The launch in 2016 of the KBA Global Standard, which aims to identify, document and conserve sites that contribute to the global persistence of wider biodiversity, and whose criteria for site identification build on those developed for IBAs, is a logical evolution of the IBA concept. The role of IBAs in conservation planning, policy and practice is reviewed elsewhere. Future technical priorities for the IBA initiative include completion of the global inventory, particularly in the marine environment, keeping the dataset up to date, and improving the systematic monitoring of these sites.
At the QEII Health Sciences Centre Emergency Department (ED) in Halifax, Nova Scotia, advanced care paramedics (ACPs) perform procedural sedation and analgesia (PSA) for many indications, including orthopedic procedures. We have begun using ACPs as sedationists for emergent upper gastrointestinal (UGI) endoscopy. This study compares ACP-performed ED PSA for UGI endoscopy and orthopedic procedures in terms of adverse events, airway intervention, vasopressor requirement, and PSA medication use.
A data set was built from an ED PSA quality control database matching 61 UGI endoscopy PSAs to 183 orthopedic PSAs by propensity scores calculated using age, gender, and the American Society of Anesthesiologists (ASA) classification. Outcomes assessed were hypotension (systolic BP<100 mm Hg or a 15% decrease from baseline), hypoxia (SaO2<90%), apnea (>30 sec), vomiting, arrhythmias, death, airway intervention, vasopressor requirement, and PSA medication use.
UGI endoscopy patients experienced hypotension more frequently than orthopedic patients (OR=4.11, CI: 2.05-8.22) and required airway repositioning less often (OR=0.24, CI: 0.10-0.59). They received ketamine more frequently (OR=15.7, CI: 4.75-67.7) and fentanyl less often (OR=0.30, CI: 0.15-0.63) than orthopedic patients. Four endoscopy patients received phenylephrine, and one required intubation. No patient died in either group.
In ACP-led sedation for UGI endoscopy and orthopedic procedures, adverse events were rare with the notable exception of hypotension, which was more frequent in the endoscopy group. Only endoscopy patients required vasopressor treatment and intubation. We provide preliminary evidence that ACPs can manage ED PSA for emergent UGI endoscopy, although priorities must shift from pain control to hemodynamic optimization.
Current policy emphasises the importance of ‘living well’ with dementia, but there has been no comprehensive synthesis of the factors related to quality of life (QoL), subjective well-being or life satisfaction in people with dementia. We examined the available evidence in a systematic review and meta-analysis. We searched electronic databases until 7 January 2016 for observational studies investigating factors associated with QoL, well-being and life satisfaction in people with dementia. Articles had to provide quantitative data and include ⩾75% people with dementia of any type or severity. We included 198 QoL studies taken from 272 articles in the meta-analysis. The analysis focused on 43 factors with sufficient data, relating to 37639 people with dementia. Generally, these factors were significantly associated with QoL, but effect sizes were often small (0.1–0.29) or negligible (<0.09). Factors reflecting relationships, social engagement and functional ability were associated with better QoL. Factors indicative of poorer physical and mental health (including depression and other neuropsychiatric symptoms) and poorer carer well-being were associated with poorer QoL. Longitudinal evidence about predictors of QoL was limited. There was a considerable between-study heterogeneity. The pattern of numerous predominantly small associations with QoL suggests a need to reconsider approaches to understanding and assessing living well with dementia.
Informed by a developmental psychopathology perspective, the present study applied a person-based approach to examine whether associations between early sociocontextual experiences (e.g., socioeconomic factors and maternal discipline practices) and preschool-age children's delay of gratification vary across profiles of children's temperamental reactivity. In addition, the study examined the direct and mediating role of children's set shifting in associations with delay of gratification within each profile. The sample consisted of 160 socioeconomically and ethnically diverse mothers and their 5-year-old children drawn from a longitudinal study of mother–child relationships. Latent profile analyses identified three profiles of temperamental reactivity distinguished by sensitivity to reward and punishment and negative affectivity. Multigroup analysis revealed maternal sensitive discipline (observed during a parent–child compliance task) at age 3.5 predicted longer delay of gratification at age 5 in the punishment reactivity/negative affectivity group. Maternal inductive reasoning discipline at age 3.5 predicted longer delay in the low temperamental reactivity group. For children with the reward reactivity/negative affectivity profile, higher family income at age 3.5 predicted longer delay of gratification at age 5, which was mediated by children's set shifting. Findings underscore the utility of person-based approaches for delineating differential developmental routes toward children's delay of gratification.
The goal of the present study was to use a methodology that accurately and reliably describes the availability, price and quality of healthy foods at both the store and community levels using the Nutrition Environment Measures Survey in Stores (NEMS-S), to propose a spatial methodology for integrating these store and community data into measures for defining objective food access.
Two hundred and sixty-five retail food stores in and within 2 miles (3·2 km) of Flint, Michigan, USA, were mapped using ArcGIS mapping software.
A survey based on the validated NEMS-S was conducted at each retail food store. Scores were assigned to each store based on a modified version of the NEMS-S scoring system and linked to the mapped locations of stores. Neighbourhood characteristics (race and socio-economic distress) were appended to each store. Finally, spatial and kernel density analyses were run on the mapped store scores to obtain healthy food density metrics.
Regression analyses revealed that neighbourhoods with higher socio-economic distress had significantly lower dairy sub-scores compared with their lower-distress counterparts (β coefficient=−1·3; P=0·04). Additionally, supermarkets were present only in neighbourhoods with <60 % African-American population and low socio-economic distress. Two areas in Flint had an overall NEMS-S score of 0.
By identifying areas with poor access to healthy foods via a validated metric, this research can be used help local government and organizations target interventions to high-need areas. Furthermore, the methodology used for the survey and the mapping exercise can be replicated in other cities to provide comparable results.
Training for the clinical research workforce does not sufficiently prepare workers for today’s scientific complexity; deficiencies may be ameliorated with training. The Enhancing Clinical Research Professionals’ Training and Qualifications developed competency standards for principal investigators and clinical research coordinators.
Clinical and Translational Science Awards representatives refined competency statements. Working groups developed assessments, identified training, and highlighted gaps.
Forty-eight competency statements in 8 domains were developed.
Training is primarily investigator focused with few programs for clinical research coordinators. Lack of training is felt in new technologies and data management. There are no standardized assessments of competence.
The present-day location of public parks should be understood in the proper social and historical context of residential segregation and urban development. In Los Angeles, discriminatory practices such as restrictive covenants were used not only for housing, but also to maintain segregated recreational spaces. In addition, the economic changes that came as a result of White flight, suburbanization, and inner city job loss brought with it a reduction in local government resources, including funds for public parks. These changes to the urban landscape disproportionately impacted low-income immigrant communities, including Latino neighborhoods. Health disparities researchers are concerned with the inequitable distribution of parks and recreation facilities because it may contribute to disparities in physical inactivity and obesity, health risks that disproportionately impact Latinos. However, much of the literature investigating disparities in the built environment fails to include a racial analysis. The current study uses a Critical Race Theory framework to examine disparities in park availability in Los Angeles. We used a unique park dataset created in ArcGIS to carry out a county-wide assessment of the availability of park features at the neighborhood level. Data come from two sources, the Los Angeles County Location Management System, which includes information on specific park features (e.g., swimming pools, parks and gardens, recreation centers) and the American Community Survey, which includes neighborhood-level sociodemographic information. A zero-inflated negative binomial regression model was used to test whether Latino immigrant neighborhood characteristics are associated with the availability of park features in Los Angeles. Results indicate that Latino immigrant neighborhoods have limited park availability. The discussion situates these findings of inequitable distribution of park resources in the appropriate social and historical context of Latinos living in Los Angeles.
Hillary Clinton is arguably the most prominent woman in American politics today. Past research suggests female politicians conform to masculine communication styles in an attempt to evade the “double bind.” Clinton’s long and varied career thus provides an important and useful case study for investigating how female politicians present themselves strategically. Drawing on research in political psychology, political communication, social psychology, and linguistics I examine whether Clinton talked “like a man” as she navigated a path toward political leadership by conducting a quantitative textual analysis of 567 interview transcripts and candidate debates between 1992–2013. Results on Clinton’s linguistic style suggest her language grew increasingly masculine over time, as her involvement and power in politics expanded. I also consider Clinton’s language in the context of her 2007–2008 presidential campaign. In 2007, Clinton’s linguistic style was consistently masculine, supporting widespread accounts of Clinton’s campaign strategy. Beginning in late 2007, however, Clinton’s language became more feminine, reflecting a shift in the self-presentational strategies advised by her campaign staff. Throughout the 2008 campaign period, Clinton’s language fluctuated dramatically from one interview to the next, reflecting a candidate—and campaign—in crisis. This study reveals hidden insight into the strategies Clinton used as she navigated through the labyrinth toward leadership. Changes in Clinton’s linguistic style reflect the performance of gendered roles, expectations of political leaders, and the masculine norms of behavior that permeate political institutions.
1) To identify the strengths and challenges of governance structures in academic emergency medicine (EM), and 2) to make recommendations on principles and approaches that may guide improvements.
Over the course of 9 months, eight established EM leaders met by teleconference, reviewed the literature, and discussed their findings and experiences to arrive at recommendations on governance in academic units of EM. The results and recommendations were presented at the annual Canadian Association of Emergency Physicians (CAEP) Academic Symposium, where attendees provided feedback. The updated recommendations were subsequently distributed to the CAEP Academic Section for further input, and the final recommendations were decided by consensus.
The panel identified four governance areas of interest: 1) the elements of governance; 2) the relationships between emergency physicians and academic units of EM, and between the academic units of EM and faculty of medicine; 3) current status of governance in Canadian academic units of EM; and 4) essential elements of good governance. Six recommendations were developed around three themes, including 1) the importance of good governance; 2) the purposes of an academic unit of EM; and 3) essential elements for better governance for academic units of EM. Recommendations included identifying the importance of good governance, recognizing the need to adapt to the different models depending on the local environment; seeking full departmental status, provided it is mutually beneficial to EM and the faculty of medicine (and health authority); using a consultation service to learn from the experience of other academic units of EM; and establishing an annual forum for EM leaders.
Although governance of academic EM is complex, there are ways to iteratively improve the mission of academic units of EM: providing exceptional patient care through research and education. Although there is no one-size-fits-all guide, there are practical recommended steps for academic units of EM to consider.
Voters and political candidates increasingly use social networking sites (SNSs) such as Facebook. This study uses data from an online posttest-only experiment (N = 183) in analyzing how exposure to supportive or challenging user comments on a fictional candidate's Facebook page influenced participants’ perceptions of and willingness to vote for the candidate, as well as whether candidate replies to each type of user comments affected these outcomes. Participants who viewed a page with supportive comments and “likes” reported more favorable perceptions of and greater support for the candidate, relative to participants who viewed a page with challenging comments. Thus, the appearance of interactivity between a candidate and other users on the candidate's Facebook page can shape the responses of those viewing the page. However, exposure to candidate replies to either supportive or challenging comments did not lead to significantly more favorable perceptions or a greater likelihood of voting for the candidate.
consider the importance and role of values in healthcare leadership?
ensure an organisational culture that is based on appropriate values?
develop my skills in values-based leadership strategies in my organisation?
As Mahatma Gandhi once said, ‘Your beliefs become your thoughts, your thoughts become your words, your words become your actions, your actions become your habits, your habits become your values, your values become your destiny’. Values permeate every aspect of our lives, shaping individual actions and giving meaning, direction and scope to our work environments and organisational cultures. Defining positive behaviours and identifying unprofessional, disrespectful or negative behaviours, values permeate and define every aspect of our work and personal lives. Values also have an emotional component: when we act in accordance with our values, we experience positive emotions; conversely, when we act against our values or are placed in situations that compromise our values, we experience negative emotions. It is this emotional component that drives us to seek values alignment in our personal and professional lives.
In healthcare, values-based leadership is particularly important. Patients seek our care often at the most vulnerable time in their lives. In their vulnerability, they must trust us to provide competent and compassionate care.